Provider Demographics
NPI:1245887249
Name:BARBER, CRYSTAL VERENELL (RD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:VERENELL
Last Name:BARBER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 UTAH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2908
Mailing Address - Country:US
Mailing Address - Phone:757-770-2971
Mailing Address - Fax:757-393-8009
Practice Address - Street 1:105 UTAH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2908
Practice Address - Country:US
Practice Address - Phone:757-770-2971
Practice Address - Fax:757-393-8009
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA720603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty